Provider Demographics
NPI:1558005199
Name:GOLLINGE, JACQUELLINE (LAC, DIPL OM)
Entity Type:Individual
Prefix:
First Name:JACQUELLINE
Middle Name:
Last Name:GOLLINGE
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12903 E CAROLINA DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4326
Mailing Address - Country:US
Mailing Address - Phone:631-707-6583
Mailing Address - Fax:
Practice Address - Street 1:2040 E 28TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-4561
Practice Address - Country:US
Practice Address - Phone:720-381-4165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002750171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist